Objectives:

• Outline the scope of the opioid epidemic as it relates to Emergency Medicine
• Detail innovative treatment options for opioid use disorder and overdose
• Discuss strategies and barriers to implementing ED-based Medication for Opioid Use Disorder (MOUD)
• Provide possible future strategies and necessary policy changes

Take-home points:

• Opioid use disorder is a disease that is often chronic and relapsing
• Prescribing buprenorphine is easy and it only takes one person to start doing it. See the show notes for resources to help.
• It’s helpful to have a champion for OUD treatment in the ED. The medical director is well positioned for this.
• Find a community champion who can help continue treatment outside of the ED
• Stigma affects both providers and patients. Learn your terms and try to be consistent with their use: opioid use disorder (OUD), Medication for Addiction Therapy (MAT), and Medication for Opioid Use Disorder (MOUD).
• Treatment for OUD can be with naltrexone, methadone, and buprenorphine. Buprenorphine is a partial opioid agonist and the best-suited for ED treatment.
• You can use the COWS score to assess your patients for opioid withdrawal.

Outside resources:

Emergency Department Contribution to the Prescription Opioid Epidemic

https://www.ncbi.nlm.nih.gov/pubmed/29373155

What Role Has Emergency Medicine Played in theOpioid Epidemic: Partner in Crime or Canary in theCoal Mine?

https://www.annemergmed.com/article/S0196-0644(18)30046-5/pdf

ACEP opioid resources

https://www.acep.org/by-medical-focus/mental-health--substance-abuse/opioids/#sm.0001e74hrth2sdxcqs82pd3l195ch

Emergency department–initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial

https://www.ncbi.nlm.nih.gov/pubmed/25919527

Resources that support medication-based treatment in the ED

https://medicine.yale.edu/edbup/

https://www.bridgetotreatment.org/

Contributors:

• John Purakal
• Maureen Gang
• Caleb Scarth
• Nate Coggins

Guests:

Gail D’Onofrio, MD, MS, is the chair of emergency medicine at Yale Medicine. She is internationally known for her work in substance use disorders, women’s cardiovascular health, and mentoring physician scientists in developing independent research careers. For the past 25 years she has developed and tested interventions for alcohol, opioids and other substance use disorders, serving as the principal investigator (PI) on several large NIH, SAMSHA, and CDC studies. She is a founding Board member of Addiction Medicine, now recognized as a new specialty, subspecialty by the American Board of Medical Specialties.

Lewis Nelson, MD, is Professor and Chair of the Department of Emergency Medicine and Chief of the Division of Medical Toxicology at Rutgers New Jersey Medical School in Newark, NJ. He is a member of the Board of Directors of the American Board of Emergency Medicine and a Past-President of the American College of Medical Toxicology. He is actively involved with several governmental and professional organizations and is an editor of Goldfrank’s Toxicologic Emergencies. His areas of specific interest include consequences of opioids, pain management, and emerging drugs of abuse.